Initial experience of an algorithm-based protocol for the community follow-up of men with prostate cancer

February 23, 2016

OBJECTIVE - To evaluate the implementation of a novel algorithm-based discharge programme for the community follow-up of men with prostate cancer.

MATERIALS AND METHODS - Men with prostate cancer considered suitable for discharge were identified from consultant-led and clinical nurse specialist telephone clinics at Nottingham University Hospitals NHS Trust.

Patients were discharged on to one of four discharge pathways: watchful waiting, androgen deprivation therapy (ADT), post-prostatectomy and post-radiotherapy. Primary care providers were asked to adhere to specific surveillance measures and refer patients back to secondary care following breach of pre-defined PSA threshold criteria. Reasons for non-compliance, re-referral and cause of death were determined for all discharged men.

FINDINGS - 573 men were discharged across all four pathways; 169 on the watchful waiting pathway, 229 on the ADT pathway, 95 on the post-prostatectomy and 80 on the post-radiotherapy pathway. All patients had a minimum 12 months follow-up. 48 of 54 (88. 9%) of men were re-referred promptly following PSA-threshold breach. Of the remaining six patients there were three refusals, one unrelated death prior to referral and two late referrals at four months. Three patients were lost to follow-up due to database non-registration and were subsequently recalled, none of whom with a PSA-threshold breach. There were three unexpected deaths attributed to prostate cancer: two were community deaths with no biochemical or clinical evidence of prostate cancer progression; one was due to a likely progressive PSA non-secreting tumour.

INTERPRETATION - Initial results suggest the algorithm-based protocol is a viable, effective and oncologically safe method for the controlled discharge of men from secondary to primary care. Longer-term follow-up, patient satisfaction and cost-effectiveness data are required to assess the true impact of the initiative. This article is protected by copyright. All rights reserved.

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